Self Referral of Dialysis Patients

Abstract

A newly appointed junior staff member of a large nephrology physicians group in a community hospital indicates his dissatisfaction with the system of referrals. He notes that after stabilizing newly evaluated kidney failure patients, continuing long-term care is arranged with one of several surrounding free standing dialysis units. The unit selected for transfer of the new patient is a proprietary facility owned by a partnership held by three of the senior renal staff members. The same physicians who referred the patient and own the unit then decide on the length of each dialysis treatment as well as other components of care such as whether or not to do nerve testing for a fee. Profits at this dialysis unit become the personal income of its owners. Concerned over abrogating his patient’s free choice, the junior nephrologist indicates his intention to resign from the group.